57% of California general practitioners refuse to treat Medicare patients because they believe those patients are more likely to file medical malpractice lawsuits

49% of California general practitioners refuse to treat uninsured patients because they believe those patients are more likely to file medical malpractice lawsuits

36% of all Maryland medical malpractice lawsuits were filed by patients who became medical assistance recipients after the medical injury (meaning that the injury may have forced their lower economic status, which could be a motivation for filing a lawsuit)

A 1992 study revealed that, though Medicaid recipients comprised 10% of the population, they only filed 5% of the medical malpractice lawsuits

Where does this bias come from? I suspect most of it comes from the insurance industry and its marketing that there are too many "frivolous" lawsuits and "runaway" jury verdicts. The insurance industry blames the trial lawyers for their need to increase doctors' insurance premiums. The doctors are thus required to pay higher premiums for liability insurance based on what the insurance companies are telling them. Then, you throw in the fact that the insurance industry continues to reimburse doctors less and less for the same procedures, and it takes more time for this reimbursement to occur.

When you add in what State Medicaid and Federal Medicare pay, which is usually much less, you get doctors getting paid lower amounts for doing the same work they had been doing, and it taking more time for them to get paid back, especially by Medicaid and Medicare. While what the insurance industry is telling the doctors is not true, it nevertheless shapes how physicians think.

I would also state that lawyer advertising on television may play a role in this misperception. A high percentage of television lawyer advertising takes place during the day, often during soap operas and talk shows. Our society may have an unconscious bias assuming the nature of the people who watch those daytime programs-the unemployed. Never mind that stay-at-home moms or dads might watch television during the day while their spouse works at a Fortune 500 company. Never mind that some people work the night shift or the graveyard shift.

This article cited above assumes that there is an unconscious bias against lower-income patients, but there is no real examination into whether it is unconscious or conscious, and on what information that biased is based.

The study results were succinctly summarized by the authors:

Contrary to popular perception, existing studies show poor patients, in fact, tend to sue physicians less often. This may be related to a relative lack of access to legal resources and the nature of the contingency fee system in medical malpractice claims.

This analysis is both correct and egregiously incorrect. It is accurate that individuals with lower education or lower income levels do not have the same access to legal resources as individuals or corporations with higher income levels. However, to cite contingency fee arrangements as a reason that poor patients do not sue as much as others is ridiculous. The very nature of the contingency fee system is that it creates a level field for would-be plaintiffs of all economic backgrounds. Under the contingency fee system, which the personal injury lawyers at our firm use for medical malpractice cases and personal injury cases, the client does not pay a single cent from the first consultation up to the time of settlement or verdict.

Our clients do not write us a check - medical malpractice attorney fees and expenses come out of the settlement or verdict. And if a case is lost, the client does not owe us any money. We accept complete financial risk for our medical malpractice cases. Whether our clients are the richest people in the world or the poorest, they all pay the same thing up front - nothing. The contingency fee system is the great equalizer that allows all of us, including lower-income individuals, to secure justice against large corporations and insurance companies that try to deny their access to the courts.

This study is amateurish, but we can only hope that it serves a purpose. Hopefully it will convince doctors that lower-income patients are not to be feared. Hopefully it will provide greater access to quality healthcare by lower-income patients. Hopefully these biases, whether real or contrived by the authors of that study, can become a thing of the past, as they should be.

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